[Case of pneumonia caused by beta-lactamase-producing and amoxicillin/clavulanate resistant strains of H. influenzae].
An 80-year-old woman presenting with fever and cough was given a diagnosis of community-acquired pneumonia. She was hospitalized and treated with ampicillin/sulbactam (ABPC/SBT) and clarithromycin (CAM). Gram stain images and sputum culture results led us to believe that the causative agent was Haemophilus influenzae. Drug sensitivity testing indicated that the H. influenzae was a beta-lactamase-positive, ABPC-resistant (BLPAR) strain. Treatment with ABPC/SBT was not clinically effective. We considered the possibility of beta-lactamase-positive amoxicillin/clavulanate-resistant (BLPACR) strains. Further testing revealed that the MIC of ABPC was 128 microg/ml, that of SBT/ABPC was 8 microg/ml, and that of AMPC/CVA was 4 microg/ml. Furthermore, genetic analysis indicated the H. influenzae to be a BLPACR-I strain. The poor clinical course eventually led to a diagnosis of BLPACR. When beta-lactamase-producing H. influenzae is cultured, the possibility of a BLPACR strain resistant to ABPC/SBT and AMPC/CVA must be considered.
Yano
Ryozo
R
Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center.
Takayanagi
Noboru
N
Kagiyama
Naho
N
Harasawa
Keiji
K
Matusita
Fumi
F
Yoneda
Kouichirou
K
Miyahara
Yousuke
Y
Yamaguchi
Shouzaburo
S
Tokunaga
Daidou
D
Saito
Hiroo
H
Kurashima
Kazuyoshi
K
Ubukata
Mikio
M
Yanagisawa
Tsutomu
T
Sugita
Yutaka
Y
D000369:Aged, 80 and over; D000667:Ampicillin / Q000494:pharmacology*; D019818:Clavulanic Acid / Q000494:pharmacology*; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006192:Haemophilus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006193:Haemophilus influenzae / Q000187:drug effects / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000096:biosynthesis
D019818:Clavulanic Acid; D000667:Ampicillin; D001618:beta-Lactamases